title: Quadriceps function following ACL reconstruction and rehabilitation: implications for optimisation of current practices.
abstract: OBJECTIVE
  To determine the most effective practices for quadriceps strengthening after ACL reconstruction.
  
  
  METHODS
  An electronic search has been performed for the literature appearing from January 1990 to January 2012. Inclusion criteria were articles written in English, German or Dutch with unilateral ACL-reconstructed patients older than 13 years, RCT rehabilitation programmes containing muscle strengthening, protocol described in detail and time frame of measurements reported. Quadriceps muscle strength and patient-reported outcomes were the endpoints. Included studies were assessed on their methodological quality using the CONSORT Checklist.
  
  
  RESULTS
  From 645 identified studies, 10 met the inclusion criteria. Seven studies found an increase in quadriceps strength after intervention programmes regardless of type of training. An eccentric exercise programme showed significantly better values for isometric quadriceps strength compared to a concentric exercise programme. The Tegner activity scale showed a significant increase in activity level for all training programmes. The Cincinnati Knee Rating System showed significant improvements in particular for the neuromuscular training group.
  
  
  CONCLUSIONS
  The evidence from this review indicates that eccentric training may be most effective to restore quadriceps strength, but full recovery may not be achieved with current rehabilitation practices. Neuromuscular training incorporating motor learning principles should be added to strengthening training to optimise outcome measurements.
  
  
  METHODS
  II.
authors.affiliation: Center for Rehabilitation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands, a.gokeler@umcg.nl.
authors.forename: Alli
authors.initials: A
authors.lastname: Gokeler
authors.forename: Marsha
authors.initials: M
authors.lastname: Bisschop
authors.forename: Anne
authors.initials: A
authors.lastname: Benjaminse
authors.forename: Greg D
authors.initials: GD
authors.lastname: Myer
authors.forename: Peter
authors.initials: P
authors.lastname: Eppinga
authors.forename: Egbert
authors.initials: E
authors.lastname: Otten
mesh_terms: D016118:Anterior Cruciate Ligament / Q000601:surgery*; D000070598:Anterior Cruciate Ligament Injuries; D059549:Anterior Cruciate Ligament Reconstruction; D005081:Exercise Therapy / Q000379:methods*; D006801:Humans; D007718:Knee Injuries / Q000534:rehabilitation* / Q000601:surgery; D007719:Knee Joint / Q000503:physiopathology; D053580:Muscle Strength; D052097:Quadriceps Muscle / Q000503:physiopathology*